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What Would #ThisNurse Say? Consumers, Hospitals & Data Holes

Photo by Thomas Leth-Olsen via Flickr Creative Commons.

Photo by Thomas Leth-Olsen via Flickr Creative Commons.

As I return to my analysis of New York Times nursing coverage after a semester break in Brazil, nursing’s recent front-page spread tempted me.  But to discuss Dionne Searcey, Eduardo Porter and Robert Gebeloff’s  article would only encourage you to read it.

Instead, I’ll push past, hoping that others see nursing as different from telephone repair, and that too many folks don’t start joining the profession just for a bigger paycheck. I want to highlight content that will further the profession and its voice in the media, not journalism that sells nursing as a solution for jumping classes.

Wednesday’s editorial, “Is That Really a Five-Star Nursing Home?”, provided a perfect replacement. In it, the Editorial Board told of Medicare’s new algorithm for telling the public which nursing homes are good or not. Go figure, the data on Nursing Homes Compare (a Medicare website similar to Hospital Compare), largely based on staffing and quality, was quite inflated; a third of the facilities lost their five-star rating after these new standards launched.

What excited me most wasn’t the promise of more accurate data, though. It was the info-heavy statement at the very end of the article:

“Perhaps the most important improvement is that by the end of 2016, the government will require all nursing homes to report staffing levels — an important determinant of quality — every quarter, using an electronic system that can be verified with payroll data.”

I’m a hospital nurse, not a nursing home nurse, and I’ve often wondered why my patients and their families lacked insight into the data behind how I do my job (how many hours I spend with each patient), or with what tools (how many patients I care for, and my level of education). While Hospital Compare provides data on quality measures, it doesn’t report or link these measures to staffing, as the Times just did in this editorial’s final statement.

In comparison, Nursing Home Compare lists staffing data for consumers to view and weigh. So, if I’m looking for a nursing home for my 97-year-old grandma, I can compare the ones in my neighborhood, and see how much time nurses spend with each resident. Even though these numbers are bloated (I mixed some basic math with some basic logic), they offer a baseline for consumers to judge from. I’d venture to guess that everyone in Big Mac America knows that more time with patients is better than less.

If I’m looking for a nursing home, this data is lovely. But my grandmother doesn’t need a nursing home. I’m shopping around for a quality hospital to care for my 57-year-old mom, who might need back surgery. Thanks to this Medicare data mismatch, I have no way of obtaining hospital staffing data. Sure, I can find info on back surgeons, but after the surgery is over, my mom will rely on nurses for her recovery. And if the Times editors just said what I think they just said – staffing should be transparent because it directly affects quality – this omission of information makes me a really unhappy consumer.

Since the government does not currently mandate reporting on hospital staffing, I, as a consumer, have no way of knowing anything about this, or where to find answers. I’m in the dark as to how each hospital staffs, which hospitals hire nurses with Bachelor’s degrees, or how one hospital compares to another in nursing care hours – all data-driven measures on the road to quality. Instead, I’m left guessing about an enormous determinant to quality for a life-altering, expensive transaction. Shocking, considering the level of analysis we demand when purchasing even simple electronic equipment.

In a world where health care bankruptcy reigns and technology creates consumer transparency for everything from cars to shaving cream, omitting information on hospital staffing is pretty senseless. And so, I’m a bit encouraged by what the Times did with this little editorial: By showing what’s becoming transparent, it highlighted what is still dangerously hidden.

This post is by Graduate Fellow, Amanda Anderson, RN. What Would #ThisNurse Say? is her media project that analyzes New York Times coverage of nursing. Amanda tweets as @12hourRN

Reducing Heart Disease Risk is Simple. So Why Don’t More Women do it?

© Ed Yourdon; CC license

© Ed Yourdon; Creative Commons license

Want to live longer? There’s really no substitute for exercise. According to the latest research published in American Heart Association journal Circulation, it only takes a few times a week to make a difference.

In a study of 1.1 million healthy women in the United Kingdom, researchers found that middle-aged women who are physically active a few times per week have lower risks of heart disease, stroke and blood clots than inactive women. Surprisingly, more frequent physical activity didn’t result in further reductions in risk, researchers said.

Specifically, women who performed strenuous physical activity– enough to cause sweating or a faster heart beat — two to three times per week were about 20 percent less likely to develop heart disease, strokes or blood clots compared to participants who reported little or no activity. Among active women, there was little evidence of further risk reductions with more frequent activity.

The women reported their level of physical activity at the beginning of the study and three years later. Researchers then examined hospital admissions and deaths in relation to participants’ responses. Follow-up was, on average, nine years. Study participants had no history of cancer, heart disease, stroke, blood clots, or diabetes and were part of the Million Women study in 1996-2001. Their average age when they joined the study was 56.

There’s no need to become a marathon runner or triathlete, either. Physical activities associated with reduced risk included walking, gardening and cycling.

“Inactive middle-aged women should try to do some activity regularly,” said Miranda Armstrong, M.Phil., Ph.D, the study’s lead author and a physical activity epidemiologist at the University of Oxford in the United Kingdom. “However, to prevent heart disease, stroke and blood clots, women don’t need to do very frequent activity as this seems to provide little additional benefit above that of moderately frequent activity.”

Despite numerous studies and data that point to the benefits of exercise, healthy diet, and managing cholesterol and blood pressure, many Americans — including nearly half of U.S. women, still seem to be in denial about their risks. So let’s review:

  • Heart disease is the leading cause of death in the United States; about 600,000 people die each year from the disease or related complications according to the CDC.
  • The American Heart Association estimates that heart disease accounts for roughly 17 percent of health care costs in the U.S. We spend nearly $109 billion every year just on coronary heart disease — including health services, medication, and lost productivity.
  • About half of all Americans (49 percent) have at least one key risk factor for cardiovascular disease (CVD) — high blood pressure, high LDL cholesterol or smoking.
  • Diabetes, being overweight or obese, physical inactivity, poor diet and excessive alcohol use also put people at higher risk of heart disease.
  • By 2030, at least 40 percent of Americans — that’s 2 in 5 —  will have  CVD; costs are projected to triple.

Women are particularly vulnerable. The National Coalition for Women with Heart Disease estimates that 42 million U.S. women are currently living with heart disease. However, many women remain uninformed about the risks. The CDC says only about half (54 percent) know it’s the number one killer of women as well as men. Almost two-thirds (64 percent) of women who die suddenly of coronary heart disease have no prior symptoms. Signs of heart attacks in women can also be different than in men, and are sometimes ignored.

Women are also more susceptible than men to what the National Heart, Lung and Blood Institute calls “broken heart syndrome,” or stress-induced cardiomyopathy. It frequently strikes previously healthy women — when extreme emotional stress results in severe (but often short-term) heart muscle failure. This is often misdiagnosed as a heart attack because symptoms are similar. However, there’s no evidence of blocked heart arteries in broken heart syndrome, and most people have a full and quick recovery.

You’ve heard it all before, but February is Heart Month, so it bears repeating: Watch your diet, manage your vital signs, quit smoking and do some type of regular physical activity. It’s easy to find excuses not to exercise. This latest study shows how little it takes to make a huge difference.

Healthstyles: Changing the conversation about substance abuse

WBAI

There are millions of families struggling with drug and alcohol abuse. They struggle to find practical tools to get help. Some never do because of the stigma involved. Some never do because of the lack of access to effective care. Too often, the one-size fits all model of treatment fails them, their families and their friends.

Tune in to Healthstyles, Thursday, February 19th starting at 1:00 PM for this 2 hour special segment and learn about a more effective and more respectful treatment for people struggling with substance use, as well as their families.

Healthstyles producers and co-hosts Diana Mason, PhD, RN, and Barbara Glickstein, RN, MPH, MS interview Carrie Wilkens, PhDthe cofounder and clinical director of the Center for Motivation and Change (CMC) and one of the authors of the book, Beyond Addiction: How Science and Kindness Help People Change.Hardcover-Beyond_Addiction_resized3

The clinical team at CMC say, “Changing a life, not just giving up a habit.”

Hear from Miriam Fridman, RN MSN, is a nurse manager on the inpatient unit at Mount Sinai Beth Israel Medical Center’s Stuyvesant Square Chemical Dependency Services. She has worked with persons struggling with substance use for over 30 years 

Click here to hear the interview with Miriam Fridman RN

Tune into Healthstyles on Thursday, February 9, 2015, from 1:00 to 2:00 PM for this 2 hour special on WBAI, 99.5 FM in New York City (www.wbai.org).

Healthstyles, January 29th: Reproductive Services and Breastfeeding

WBAI

The results of the national and state elections in 2014 suggest that we will continue to see efforts to restrict women’s right to abortions and access to contraception and abortion services. But even in states where the right to abortion is considered safeguarded, access to abortion services may be limited. Healthstyles producer Diana Mason, PhD, RN, interviews Diana Taylor, PhD, RN, Professor Emerita at the University of California at San Francisco School of Nursing and Research Faculty for the Advancing New Standards in Reproductive Health Program, about these issues and strategies to increase this access that are underway in California and could serve as a model for other states.

On the second half of Healthstyles, Diane Spatz, PhD, RN, Professor of Perinatal Nursing and the Helen M. Shearer Term Professor of Nutrition at the University of Pennsylvania School of Nursing, talks about some of the policy issues and latest scientific findings on breastfeeding, including some fascinating information about how breast milk can actually be used as a therapeutic intervention for sick infants who cannot eat.

So tune into Healthstyles on Thursday, January 29, 2015, at 1:00 on WBAI, 99.5 FM in New York City (www.wbai.org). Or click here to listen to the program anytime:

Healthstyles is sponsored by the Center for Health, Media & Policy at Hunter College, City University of New York.

The Upside of ADHD

Lara Cheslow photoThis guest post is written by Lara Cheslow, a cell biology and neuroscience university graduate. Lara has researched in a neuroscience lab and currently teaches math and science. She aspires to become a science writer to keep learning and reporting on exciting new research developments.

Attention deficit hyperactivity disorder is the most commonly diagnosed psychiatric illness in US school children. According to the most recent CDC report, 11% of kids between the ages of 4 and 17 have been diagnosed with ADHD at some point in their lives. Research suggests that ADHD and ADDers may have lower-than-average levels of dopamine, the neurotransmitter that helps us zero-in on important things around us. ADHD is usually treated using stimulants, like amphetamines, that are classified as Schedule II drugs alongside methamphetamines and morphine. These medications, like Adderall, Concerta, and Focalin, spike their users’ dopamine levels, which allows them to tune out buzzing peripheral details that otherwise vie for attention.

ADHD is characterized by inattention, hyperactivity, and impulsivity. According to Yale associate professor of public health, Dr. Jason Fletcher, adults with persisting childhood ADHD are “much less likely to be employed at age thirty, and those who [have] jobs [earn] over thirty percent less each year than individuals who [are] not diagnosed with ADHD.”

Outside structured settings, however, the apparent curse can actually be a blessing. Thomas Edison is the historical poster boy for retrospectively-diagnosed ADHD. An inquisitive but unfocused student, he was branded “addled” and dull by his grade school teacher. Edison lasted three months in grade school before his mother insisted on homeschooling him. Free to pursue his insatiably varied interests at home, Edison read voraciously while honing his mechanical and chemical skills.

David Neeleman, the founder and head of JetBlue Airways, is a proud ADDer. Though he barely scraped by in college, the CEO now uses his disorder as an asset. “If someone told me you could be normal or you could continue to have your ADD, I would take ADD,” says Neeleman. “My ADD brain naturally searches for better ways of doing things.”

So if the three pillars of ADHD (inattention, hyperactivity, and impulsivity) equal creativity, energy, and curiosity in less rigid settings, why do we characterize these traits as a disorder? A new neurological study conducted by Washington University’s Dr. Dan T.A. Eisenberg suggests a biological justification for the retention of these traits in our collective gene pool, despite their clash with structured lifestyles. Dr. Eisenberg examined genetic differences among nomadic and settled factions of Ariaal tribesmen in northern Kenya. Specifically, the research correlated nourishment and the presence of the DRD4/7R allele, which is linked to ADHD and codes for a less sensitive dopamine receptor. Among roaming nomads with a dynamic lifestyle, those with the less responsive receptor were better nourished. Settled and organized farmers, on the other hand, were better nourished if they lacked the insensitive receptor gene.

For individuals who flit smoothly between changing landscapes, ADHD can be an evolutionary advantage. Like the agrarian Ariaal lifestyle, our lives are generally structured, so it’s no surprise that the disorder is at odds with many of our activities. In school especially, ADHD symptoms can be disruptive and derailing to teachers organizing a regimented curriculum for their classes. But when a round peg doesn’t fit a square hole, which one needs to change?

written by Lara Cheslow

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